Invisalign Clear Aligner Orthodontic Therapy: Questionnaire
1. I am:
An adult considering invisalign
A teen considering invisalign
An adult considering invisalign for my child
2. Which best describes the orthodontic therapy you've had in the past?
Braces
Palate expander
Invisalign Orthodontics
Space mantainer
Headgear
Retainers
Never had orthodontic treatment
2a. If you have experienced Dental Braces relapse. When did you first become aware of the problem?
Less than 1 year
1-5 years
5-20 years
20+ years
Never had Orthodontic therapy
Never had any dental braces relapse
My teeth have shifted, but I've never had orthodontic therapy
Not applicable
3. Do you have all your adult teeth (except your wisdom teeth)?
Yes
No
Not sure
4. What do you hope to achieve from Invisalign Orthodontic Therapy?
More even bite
Less crowding
Healthier gums and bone
Reduce overbite
Straighter teeth
Improve profile
Make brushing easier
Close gaps
Improve my smile
Make flossing easier
Increase confidence
Reduce staining and plaque buildup
None of the above
5. How many times per day do you brush?
1
2
3 or more
Less than 1
6. How many times per day do you floss?
0
1
2 or more
7. Which statement do you agree with?
A healthy mouth is an important part of my overall health.
A beautiful smile is very important to me.
My primary goal is to have straight teeth, but, general dental health is important too.
My primary goal is to have excellent dental health.
None of the above.
8. Do you have any orthodontic insurance coverage?
Yes
No
I don't know
9. Can you benefit from a health savings account (HSA) flexible spending account (FSA)?
Yes
No
I don't know
10. If everything works out, when would you like to start Invisalign Ortodontic Therapy?
Immediately
In the next 6 months
Next January
As soon as I can arrange the finances
Not sure yet
11. How much research have you done?
Just started
Spoke with my dentist about Invisalign but have not had an evaluation
Have an appointment scheduled for an evaluation
Had an Invisalign consultation and would like a second opinion
Ready to schedule an appointment to start Invisalign treatment
12. Have you ever been told that you were not a candidate for Invisalign?
Yes
No
Sort of
Not sure
13. If you have had an Invisalign specific consultation, was your treatment classified as:
Basic
Standard
Advanced
Complex
I haven't had an Invisalign consultation
I was told I couldn't have Invisalign
Not sure
14. Would you be opposed to having your teeth whitened by an oral antiseptic agent during the therapy?
Yes
No
Possibly
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